凝血功能指标与危重症患者预后的相关性研究

Investigation of correlation of coagulation function indicators and prognosis of critically sick patients

目的 探讨凝血指标对危重症患者预后的判断价值.方法 选取2013年1月至12月郑州大学第一附属医院综合ICU住院患者940例,排除预先使用抗凝剂如口服华法林、鼠药中毒者.记录患者入院24 h内的血凝试验资料及其他临床资料,按出院时结局分为存活组及死亡组,应用单因素分析和多因素Logistic回归模型探索与危重患者预后相关的因素.结果 单因素分析显示,存活组和死亡组患者在年龄、血小板、降钙素原（PCT）、血糖、乳酸水平、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、白蛋白、D-二聚体、凝血酶原时间（PT）、纤维蛋白原（FIB）、急性生理学与慢性健康善评分系统Ⅱ（APACHEⅡ）评分等方面比较差异有统计学意义（P＜0.05）.多因素Logistic回归结果显示：控制年龄、血小板、PCT、血糖、ALT、AST、白蛋白、PT、FIB、APACHEⅡ评分等混杂因素后：D-二聚体（OR=1.021,95％CI：1.002～ 1.04,P=0.032）、乳酸（OR=1.144,95％ CI：1.037 ～1.262,P=0.007）.结论 凝血功能异常是危重患者死亡的高危因素,血清D-二聚体水平、乳酸水平是危重患者死亡的独立危险指标,可反映其病情严重程度及预后.

Objective To investigate the predictive value of coagulation function on critically sick patients.Methods A total of 940 critically sick patients admitted to intensive care unit were enrolled in this study from January 2013 to December 2013.Patients with oral warfarin or rodenticides poisoning were excluded.The relevant clinical data were recorded within 24 hours from they checked in.The patients were divided into survival group and non-survival group according to the end of the patients at discharge.Application of univariate and multivariate logistic regression analysis were conducted to investigate coagulation function associated with the prognosis.Results Univariate analysis demonstrated that age,platelet count,PCT（procalcitonin）,blood glucose,lactic acid level,ALT （alanine aminotransferase）,AST （aspartate aminotransferse）,albumin level,D-dimer,PT（prothrombin time）,FIB（fibrinogen）,APACHE Ⅱ score between the two groups were significantly different （P 〈 0.05）.Multivariate logistic regression analysis showed that the elevation of D-dimer level and lactic acid remained an independent predictor of critically sick patients after the above factors were controlled except fir D-dimer and lactic acid.The relative risk of D-dimer is 1.021,with 95% confidence interval（95% CI） was 1.002-1.04（P =0.032）.The relative risk of lactic acid was 1.144 and 95% CI was 1.037-1.262（P =0.007）.Conclusions Abnormal coagulation function is high risk factor for death of critically ill patients.High concentration of d-dimer and lactic acid are independent predictors in critically ill patients,which can reflect the severity of disease and the prognosis.